Pancreatic sphincter hypertension (PSH) is one of the causes of recurrent pancreatitis. The diagnosis can be established by direct measurement of pancreatic sphincter pressures at pancreatic sphincter manometry. This procedure is not without risks, and in cases with PSH, it certainly carries a higher risk of post procedure pancreatitis. The treatment of this disorder is pancreatic sphincterotomy, which on its own carries risk of acute pancreatitis. Therefore it is important to establish the diagnosis reliably before undertaking this procedure. In order to overcome the false positive readings that are possible in sphincter manometry, we proposed to use secretin stimulated endoscopic ultrasound (SSEUS) to measure pancreatic ductal response as an adjunctive method to aid and supplement the diagnosis. Here we describe 3 cases in which this was carried out to optimal effect.
We report 2 cases where treatment of achalasia type symptoms due to severe non-specific oesophageal dysmotility have shown symptom resolution and manometric improvement to intrasphincteric botulinum injections either by itself or in combination with oesophageal dilatation.